Pharma companies with 'superior R&D·K-made drug ingredients

will receive preferential pricing starting this year

Will establish a process for expanding RSA for drugs treating severe diseases drugs·for increasing the pricing of drugs facing supply shortages

The Health Insurance Policy Review Committee decided on this year’s implementation scope of the 2nd National Health Insurance Plan

Starting this year, under the 2nd comprehensive National Health Insurance Plan (hereafter, referred to as NHI Plan), the government will provide preferential drug pricing for new drugs developed by pharmaceutical companies with high R&D costs.

 

Additionally, the plan will expand the scope of the risk sharing agreement (RSA) for severe diseases.

 

This year’s plan includes offering preferential drug pricing for national essential medicines that use drug ingredients manufactured in South Korea.

 

Additionally, it includes a process for promptly increasing the price of medicine with a supply shortage.

 

On the 25th, the Ministry of Health and Welfare (MOHW) held the 9th Health Insurance Policy Review Committee, conducted a review, and made a decision on the implementation of the 2nd comprehensive National Health Insurance Plan 2024.

 

This year's implementation plan for the NHI Plan consists of four major directions: ▲Ensuring essential healthcare supply and fair compensation ▲ Reducing healthcare disparities and ensuring a healthy life ▲ Improving the financial sustainability of health insurance ▲ Establishing a stable supply system and a good circulation structure.

 

The plan includes the 15th primary task and the 75th detailed task.

 

Based on stable financial management, the MHOW has announced plans to invest over KRW 1.4 trillion in essential medical areas this year to support the implementation of the four major tasks outlined in the previously announced healthcare reform measures.

 

Will establish a stable supply chain·good circulation structure Pharmaceutical companies are expected to focus their attention primarily on this year’s NHI Plan, particularly on innovative new drugs and supply stabilization.

 

The MOHW announced that it would improve the system for supporting the development of innovative medical technology that provides treatment options for diseases without treatment and also the system for addressing supply shortages.

 

For innovative new drugs, the MOHW will specify the criteria for innovativeness, aiming to offer a flexible scope for the consideration of economic evaluation.

 

The plan will provide preferential pricing for drugs developed by pharmaceutical companies with a high proportion of R&D investment.

 

It also includes measures to expand the scope of RSA for treatments used to treat severe diseases that irreversibly worsen the quality of life.

 

In terms of stabilizing supply shortages, the plan will set the basis for providing preferential drug pricing for national essential medicines that use ingredients manufactured in South Korea.

 

And it will also include a process for promptly increasing the prices of drugs with supply shortages.

 

In addition, it will establish a system for selecting and monitoring essential medical supplies facing shortages.

 

In terms of medical devices, the plan involves expanding the deferment criteria and period for innovative medical devices' evaluation and extending their pre-use period in medical settings.

 

Furthermore, it aims to expand the utilization of the National Health Insurance data for public and scientific research purposes and for self-directed health management.

 

It will also support international cooperation efforts.

 

The plan involves increasing the provision of big data to private entities, allowing the external transfer of low-risk pseudonymized information, and supporting the utilization of medical data through health information highways.

 

This year’s National Health Insurance fund is estimated to be KRW 2.6 trillion, currently in the black.

 

However, the MOHW announced plans to manage the finances efficiently, considering prolonged use of the emergency medical system, changes to medical usage, and other circumstances.

 

Additionally, over KRW 1.4 trillion will be invested in this year’s essential healthcare field.

 

The MOHW will ensure stable finance management and support the implementation of the reform package announced in February.

 

In Q1, over KRW 1.12 trillion will be invested to strengthen compensation in shortages such as childbirth, pediatrics, and critical emergencies.

 

Additionally, in Q2, more than KRW 27.6 billion will be allocated to enhance compensation in medical fields focusing on severe disease and essential healthcare.

 

In Q3, KRW 50 billion will be invested to compensate the field focusing on severe psychological disorders.

 

In Q4, over KRW 150 billion will be invested to expand the implementation of an alternative payment system to solve the regional and essential healthcare gaps.

 

Will provide essential healthcare·reasonable compensation Investments will be increased in pediatric surgery and treatments, as well as in closed wards within tertiary general hospitals with high workloads and resources but relatively low evaluation.

 

In 2023, medical institution revenue and expenses, the impact of the third phase of relative value unit revision, the expansion of panel hospitals, and cost surveys and analyses for fee adjustments will be analyzed.

 

The results report is scheduled to be released in the second half of this year.

 

A public policy cost will be introduced to maintain maternity infrastructure and to sustain personnel and facilities in the severe pediatric field.

 

The MOHW plans to implement six pilot businesses with an alternative payment system.

 

This system will offer differential compensation based on the quality of medical assessments and the achievement of treatment goals, not quantity.

 

In detail, the post-management compensation of the hospitals offering services of children’s public specialized medical centers will be expanded from 9 to 14 hospitals.

 

The first-year business will be implemented for hospitals participating in strengthening cardio-cerebrovascular disease network and a medical system for severe diseases.

 

The implementation of a pilot business will be reviewed following a research on establishing a model for an emergency medical center·a mother and child medical center·a regional medical program pilot business.

 

The MOHW also plans to establish a basis for payment system reform, including measures for innovative accounts or innovative centers and an achievement-centered review and evaluation system.